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Background: The COVID-19 pandemic has underscored the impact of Social Determinants of Health (SDH) on adolescents' Quality of Life (QoL), especially in vulnerable communities. While most research has focused on adults or general clinical conditions, this study addresses the gap in adolescent-specific COVID-19 impacts, emphasizing SDH's role in Brazilian youth's health outcomes. Methodology: This cross-sectional study analyzed 235 adolescents from 89 cities in a northeastern state of Brazil, registered in the Unified Health System's notification system, with data collected nationally in 2022 and referring to the years 2020, 2021 and 2022. Statistical tests, including the Levene test for variance equality, Student's t-test, and ANOVA with a 95% confidence interval, were used, supplemented by the Games-Howell multiple comparison test. The study found lower scores in vitality and mental health domains. Males showed higher scores across all domains (p < 0.001). Results: Adolescents aged 10 to 14 scored higher in the vitality domain. Those who engaged in physical activity had better scores in general health, vitality, and mental health domains. Adolescents with sleep difficulties had lower scores in pain, general health, vitality, and mental health domains. Additionally, those living with high-risk individuals had lower scores in vitality and mental health domains. Conclusion: SDH related to demographic factors, physical activity, and sleep quality significantly impacted adolescents' QoL, particularly affecting vitality and mental health. [ABSTRACT FROM AUTHOR]

Background: Human immunodeficiency virus (HIV) infection is a health problem in Brazil and worldwide. Without treatment, the infection can progress to Acquired Immunodeficiency Syndrome (AIDS), with a high mortality potential. The objective of this study was to analyze the time trend of AIDS mortality in Brazil, macro-regions, federal units and their respective capitals, from 2012 to 2022. Methods: This is a time-series study of all AIDS deaths in Brazil from 2012 to 2022. The study included the annual number of deaths and the crude and standardized mortality rates. The Joinpoint regression model was used for the time analysis of the standardized rates. Annual percentage change (APC) and average annual percentage change (AAPC) were calculated. A 95% confidence interval (CI) and a 5% significance level were used. Results: During the period analyzed, 128,678 AIDS deaths were recorded in Brazil, with a crude mortality rate of 6.3/100,000 and a standardized mortality rate of 5.3/100,000. From 2012 to 2020, three regions showed a declining trend in AIDS mortality: Central-West (AAPC − 2.3%; 95%CI -4.3 to -0.21; p = 0.03), Southeast (AAPC − 5.6%; 95%CI -6.8 to -4.0; p < 0.001), and South (AAPC − 4.4%; 95%CI -5.27 to -3.6; p < 0.001). There was also a downward trend in 10 states and 10 capitals. There was an increase in the number of deaths from 2020 onwards in the North, Northeast and Southeast regions compared to 2019. Conclusion: There was a downward trend in AIDS mortality from 2012 to 2020 and an upward trend from 2020 to 2022. The regional differences observed could reflect the social disparities that exist in Brazil. In addition, the Covid-19 pandemic has had an impact on the process of dealing with HIV in Brazil. [ABSTRACT FROM AUTHOR]

Objective: To characterize the epidemiology, identify trends in prevalence, seasonality, and risk factors for orofacial clefts (OFC), selecting the São Paulo state (SPS) population database. Design: A population-based study to estimate the OFC prevalence trends in recent years, stratified by maternal age and SPS geographical clusters. Setting: All live births (LB) with OFC in SPS from 2008-2019. Patients: 5342 cases of OFC among 7 301 636 LB. Interventions: Not applicable. Main outcome measures: OFC prevalence trends, annual percent change (APC) with a 95% confidence interval, and seasonality. Results: We found an OFC prevalence of 7.3/10 000LB in SPS, Brazil. Among all the cases, the majority were male (57.1%), Caucasian (65.4%), 77.8% born at term, 75.8% weight >2500 g, 97.1% singleton, and 63.9% of births were by cesarean section. From 2008-2019, SPS presented a stationary OFC prevalence trend; in São Paulo city, the highest APC was observed (0.05%); the maternal age group with the highest OFC prevalence rate was ≥35 years (9.2/10 000LB). We identified the existence of seasonal variation based on the conception date in the final months of the year, corresponding to the spring season (P <.001). Conclusion: OFC had a stationary prevalence trend in recent years, with the highest prevalence in the Central North Cluster and ≥35 years maternal age group. Seasonality was observed in the spring season, and congenital malformation of lips was the most common associated pathology. This population-based study is the first to summarize the current epidemiology of OFC in SPS. [ABSTRACT FROM AUTHOR]

There is a significant increase in the use of complementary and alternative medicine (CAM) by infertile patients. This study aimed to assess the prevalence of CAM use by infertile patients. This review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The required data were obtained by searching English databases (PubMed and Web of Science) as well as Google Scholar as an additional source of records. We included cross-sectional studies published in English journals up to March 2023 that examined the prevalence of CAM use among infertile patients in different countries. The retrieved articles were independently assessed by two reviewers. Discrepancies were resolved by discussion with the intent to reach a consensus. We reviewed 1192 documents. From these, 29 studies were included in this systematic review and meta-analysis. The results of meta-analysis conducted on 32, 804 infertile patients showed a prevalence rate of CAM use between 26.3% [95% confidence interval (CI): 21.7%-31.3%] and 96.1% (95% CI: 95.7%-96.5%) in various countries. The pooled prevalence rate calculated by the random effects model showed that, overall, 54% (95% CI: 46%-61%) of both infertile women and men used CAM, whereas 55% (95% CI: 47%-67%) of infertile women and 29% (95% CI: 17%-41%) of infertile men reported treatment with CAM. More than half of the infertile patients used CAM. Therefore, healthcare practitioners need to be aware of this practice to better provide care for infertile patients. Further studies should examine the reasons for CAM use by infertile patients. [ABSTRACT FROM AUTHOR]

Background: Oral cancer is one of the most common cancers in China and seriously threaten life and health of Chinese people. We analysed the trends and disparities of oral cancer mortality rates and the disease burden of oral cancer in China from 2006 to 2021 to provide a reference for its prevention and control. Methods: Annual death data for oral cancer was gleaned from the China Death Surveillance Database. The age-standardized mortality rate (ASMR), annual percentage change (APC), and average APC (AAPC) were used to analyze the trend of mortality. Loss of life expectancy (LLE) and years of life lost (YLL) were adopted to assess disease burden. Results: From 2006 to 2021, the overall ASMR of oral cancer lightly declined (AAPC: − 0.97%; 95% CI: − 1.89%, − 0.04%), and the similar trend was observed among females (AAPC: − 1.22%; 95% CI: − 1.89%, − 0.55%). The ASMR of males was 2.31–3.16 times higher than that of females per year. The median of LLE for overall, males and females caused by oral cancer from 2006 to 2021 were 0.05, 0.06 and 0.03 years, respectively. There was a decrease of standardized YLL rate from 2006 to 2021 for overall (AAPC: − 1.31%, 95% CI: − 2.24% ~ − 0.37%) and for female (AAPC: − 1.63%, 95% CI: − 2.30% ~ − 0.95%). ASMR in urban areas was 1.02–1.28 times higher than that in rural areas from 2006 to2011, but 0.85–0.97 times lower in urban areas than that in rural areas from 2018 to 2021. The disease burden was higher in urban areas than in rural areas in 2006, whereas the reverse was observed in 2021. Conclusions: There are severe health gaps and disparities in trends between sexes and different areas in China. Males and rural populations need to be focused on targeted interventions for the main influencing factors. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is one of the most common cancer types worldwide. Its increasing mortality trends, especially in emerging countries, are a concern. The aim of this study was to analyse mortality trends and spatial patterns of CRC in the state of Sergipe, Brazil, from 1990 to 2019. Trends were calculated using data from the Online Mortality Atlas and Joinpoint Regression Program 4.8.0.1. Spatial analyses were performed using the empirical Bayesian model and Moran indices calculated by TerraView 4.2.2 between 1990 to 1999, 2000 to 2009 and 2010 to 2019. A total of 1585 deaths were recorded during the study period, with 58.42% among females. Trends were increasing and constant for both sexes and all age groups studied. The highest mean annual percent change was 6.2 {95% Confidence interval (CI) 3.4;9.0} for males aged +65 years and 4.5 (95% CI 3.2;5.8) for females aged 50–64 years. There was positive spatial autocorrelation for both sexes in all periods studied when using the Moran index for Bayesian rates. In summary, a consistent trend of increasing colorectal cancer (CRC) mortality has been observed overall. Nevertheless, an altered spatial distribution among males has emerged over the studied period. [ABSTRACT FROM AUTHOR]

To examine the associations between daily variations of coarse Particulate Matter(PM10) and/or sulfur dioxide(SO2) and mortality. The Poisson Generalized Linear Model(GLM) was employed to analyze the relationship between ambient air pollutants such as PM10 and SO2 and mortality. For each 10 μg/m3 increase in PM10, the overall mortality risk was found to be 1.022-fold high on the previous-eighth-day(lag 7) (RR, 95%CI:1.002–1.042) in the unadjusted model; 1.031-fold high in men (RR, 95%CI:1.005–1.058); 1.024-fold high in those aged 65 and over (RR, 95%CI:1.001–1.048). Also, the risk of death in men was 1.028-fold high in the model adjusted on the previous- eighth-day(lag 7) (RR, 95%CI:1.002–1.055). Mortality risk was found to be 1.088-fold high in 10 μg/m3 increase in SO2 under 65 years in males in the previous-third-day(lag 2) in the unadjusted model, and the risk of death was found to be 1.086-fold (RR, 95%CI:1.007–1.164) high in males in the adjusted model. [ABSTRACT FROM AUTHOR]

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Objectives: To estimate socioeconomic inequalities in the maternal perception of children's oral health from a birth cohort study in Brazil. Methods: The data from this study were collected through perinatal interviews and at the 48‐month follow‐up from the 2015 Pelotas Birth Cohort Study. The main outcome was the maternal perception of children's oral health, dichotomized into positive (good/very good) and negative (fair/bad/very bad). The secondary outcome was untreated dental caries (absence and presence, according to the ICDAS index – International Caries Detection and Assessment System). For the statistical analysis, the absolute inequality index (Slope Index of Inequality – SII) and the relative concentration index (Concentration Index – CIX) were used. Analyses were stratified by maternal educational level, family income and wealth index. Results: The prevalence of outcomes was 19.4% (95% CI 18.2; 20.7) for the negative maternal perception of children's oral health and 15.6% (95% CI 14.4; 16.8) for untreated dental caries. Socioeconomics inequalities were observed in negative maternal perception of children's oral health in both absolute and relative terms. A SII of −16.6 (95% CI −20.8; −12.5) was observed for family income, with higher prevalence in poor families. A higher prevalence of the negative maternal perception of children's oral health was observed in mothers without any educational level or a few years of study (CIX −21.1 [95% CI −24.5; −17.7]). Conclusions: This study demonstrates socioeconomics disparities in the maternal perception of children's oral health and in the prevalence of untreated caries in children. A higher concentration of negative maternal perception of children's oral health was identified among the most socioeconomically vulnerable individuals. The findings reinforce the presence of socioeconomic inequalities in subjective measures about children's oral health. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to examine individual and contextual factors associated with the frequency of dental service utilization among adolescents, adults and older adults Brazilians. Methods: This cross‐sectional study used secondary data from the Brazilian 2019 National Health Survey (94 114 individuals). The outcome 'when was your last dental appointment?' was categorized into three groups: up to 1 year, more than 1 year and never had a dental appointment. Andersen's behavioural model was used to select contextual and individual variables. Multinomial logistic regression analysis was performed to calculate the odds ratio (OR) and 95% confidence intervals (95% CI). Results: The following variables showed increased probability to the outcome had the last dental appointment more than 1 year ago: older adult, illiterate or incomplete primary school, and without private dental insurance. The outcome never had a dental appointment was significantly associated with illiterate (OR 26.65; 95% CI 17.63–40.29), male (OR 2.38; 95% CI 2.17–2.61), without private dental insurance (OR 5.20; 95% CI 3.48–7.76), self‐rated oral health as bad or very bad (OR 2.67; 95% CI 2.31–3.09), household not enrolled in primary care teams (OR 1.29; 95% CI 1.11–1.49), household in a rural area (OR 1.86; 95% CI 1.69–2.05), high household crowding (OR 1.08; 95% CI 1.04–1.14) and low household income per capita (OR 0.99; 95% CI 0.99–0.99). Conclusions: This study showed that contextual and individual factors induce inequity in dental appointments. Moreover, Andersen's behavioural model demonstrated inequitable access for dental services in Brazil, in which social structure and enabling characteristics, rather than the need for the service, determine who receives health care. Living in a household enrolled in primary care teams favoured regular dental appointments. Thus, these findings may help policymakers improve health access by expanding coverage of dental services in primary health care. [ABSTRACT FROM AUTHOR]

Policy PointsPolicymakers should invest in programs to support rural health systems, with a more targeted focus on spatial accessibility and racial and ethnic equity, not only total supply or nearest facility measures.Health plan network adequacy standards should address spatial access to nearest and second nearest hospital care and incorporate equity standards for Black and Latinx rural communities.Black and Latinx rural residents contend with inequities in spatial access to hospital care, which arise from fundamental structural inequities in spatial allocation of economic opportunity in rural communities of color. Long‐term policy solutions including reparations are needed to address these underlying processes. Context: The growing rate of rural hospital closures elicits concerns about declining access to hospital‐based care. Our research objectives were as follows: 1) characterize the change in rural hospital supply in the US South between 2007 and 2018, accounting for health system closures, mergers, and conversions; 2) quantify spatial accessibility (in 2018) for populations most at risk for adverse outcomes following hospital closure—Black and Latinx rural communities; and 3) use multilevel modeling to examine relationships between structural factors and disparities in spatial access to care. Methods: To calculate spatial access, we estimated the network travel distance and time between the census tract–level population‐weighted centroids to the nearest and second nearest operating hospital in the years 2007 and 2018. Thereafter, to describe the demographic and health system characteristics of places in relation to spatial accessibility to hospital‐based care in 2018, we estimated three‐level (tract, county, state‐level) generalized linear models. Findings: We found that 72 (10%) rural counties in the South had ≥1 hospital closure between 2007 and 2018, and nearly half of closure counties (33) lost their last remaining hospital to closure. Net of closures, mergers, and conversions meant hospital supply declined from 783 to 653. Overall, 49.1% of rural tracts experienced worsened spatial access to their nearest hospital, whereas smaller proportions experienced improved (32.4%) or unchanged (18.5%) access between 2007 and 2018. Tracts located within closure counties had longer travel times to the nearest acute care hospital compared with tracts in nonclosure counties. Moreover, rural tracts within Southern states with more concentrated commercial health insurance markets had shorter travel times to access the second nearest hospital. Conclusions: Rural places affected by rural hospital closures have greater travel burdens for acute care. Across the rural South, racial/ethnic inequities in spatial access to acute care are most pronounced when travel times to the second nearest open acute care hospital are accounted for. [ABSTRACT FROM AUTHOR]

Copyright of Health Sciences Journal / Revista Ciências em Saúde is the property of Hospital de Clinicas de Itajuba - Associacao de Integracao Social de Itajuba and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Accessibility of healthy food is an important predictor for several health outcomes, but its association with life expectancy is unclear. We evaluated the association between U.S. Department of Agriculture's Food Research Atlas measures of healthy food accessibility and life expectancy at birth across contiguous U.S. census tracts using spatial modeling analysis. Both income and healthy food accessibility were associated with life expectancy at birth, as indicated by shorter life expectancy in low-income census tracts when comparing tracts with similar healthy food accessibility level, and in low-access tracts when comparing tracts with similar income level. Compared to high-income/high-access census tracts, life expectancy at birth was lower in high-income/low-access (− 0.33 years; 95% confidence interval − 0.42, − 0.28), low-income/high-access (− 1.45 years; − 1.52, − 1.38), and low-income/low-access (− 2.29 years; − 2.38, − 2.21) tracts after adjusting for socio-demographic characteristics and incorporating vehicle availability. Effective interventions to increase healthy food accessibility may improve life expectancy. [ABSTRACT FROM AUTHOR]

Physical frailty has been described as a complex geriatric syndrome. Independent of frailty, older people have been showing an increased health care services utilization. The objective is to assess an interaction effect between frailty and education on the association with the use of health services in community-dwelling older Brazilians. This is a cross-sectional study. The study was conducted with community-dwelling older Brazilian individuals. The sample had 5,473 older adults derived from the FIBRA Study. The definition of frailty was made using the physical frailty phenotype. The level of education was assessed by complete years of schooling. The use of health services was assessed by the occurrence of hospitalization, for individuals receiving home visits and having attended four or more medical consults in the past 12 months. The robust Poisson regression model with a robust error variance was used to estimate the prevalence ratio (PR) and its 95% confidence intervals to set the association between frailty and use of health services, considering the interaction between frailty and education in final model. Considering all sample, 16.4% were hospitalized, 14.1% received home visits, and 48.2% attended four or more medical consults. The interaction term between frailty and education was statistically significant only for hospitalization, showing a higher prevalence of health services utilization among pre-frail (PR1.68 95% CI 1.15–2.47) and frail (PR1.77 95% CI 1.08–2.90) older individuals with low education compared to non-frail highly educated peers. Low-educated and frail older people were more likely to be hospitalized and should be carefully looked after by health professionals. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the socioeconomic disparities in untreated dental caries in early childhood according to socioeconomic characteristics in three birth cohorts in Southern Brazil. Methods: The socioeconomic data to this study were collected at the 48‐month follow‐up and oral health studies of 1993, 2004 and 2015 Pelotas birth cohort studies. The outcome was untreated dental caries in children aged 6 (1993 cohort), 5 (2004 cohort) and 4 years (2015 cohort), dichotomized into absence/presence. Analyses were stratified by maternal skin colour/race, maternal education and family income. For statistical purposes, the prevalence difference, relative risk and absolute and relative indices of health inequality (Slope Index of Inequality–SII and Concentration Index–CIX) were used. Results: The prevalence of untreated dental caries in primary dentition was 63.4%, 45.5% and 15.6%, in 1993, 2004 and 2015 cohorts, respectively. The prevalence of untreated dental caries was concentrated in the poorest quintile and lower maternal education group in both absolute (SII) and relative (CIX) measures of inequality, being characterized as a pro‐poor event. A higher risk of untreated caries was found in the poorest quintile of family income compared with the richest quintile in the 1993 cohort (RR 1.44 [95% CI 1.05; 1.98]). That risk was higher considering the 2004 Cohort (RR 1.78 [95% CI 1.42; 2.23]) and 2015 cohort (RR 4.20 [95% CI 2.97; 5.94]) data. Conclusions: Over the course of two decades, a higher prevalence of untreated dental caries is concentrated among the most socioeconomically deprived children. [ABSTRACT FROM AUTHOR]

Objectives: Obtaining robust evidence about the local mortality levels, trends and impact of oral cavity/base of tongue cancers and lip cancer, especially for women, is imperative in the fight against cancer. This descriptive retrospective ecological time‐series study explored trends in oral cavity/base of tongue cancers and lip cancer mortality rates for women in Brazil from 1980 to 2018, by geographic region and anatomical location. Methods: The crude and age‐adjusted annual mortality rates were obtained by sex, anatomical location and macro‐regions of Brazil. The number of deaths from oral cavity/base of tongue cancers and lip cancers in Brazil was based on official population counts and estimates. The annual percentage change was calculated based on age‐adjusted rates. Data set were analysed using the Joinpoint Regression program. Results: A total of 81,918 individuals died of oral cavity/base of tongue cancers and lip cancer between 1980 and 2018 in Brazil. The age‐adjusted mortality rate for women was 0.47 and 0.57 per 100,000 in 1980 and 2018, respectively. The cumulative female mortality rates standardized by age were 0.01/100,000 for lip cancer and 0.5/100,000 for oral cavity and base of tongue cancers. A decrease in deaths related to oral cavity and base of tongue cancers was identified in the 1980s; however, over the last two decades, there has been an increase in the number of deaths of women with cancer at the base of tongue and neighbouring areas and on the floor of mouth. Importantly, Brazilian regions showed wide variability in trends of oral cavity, base of tongue and lip cancers rate and, in 2018, the regions with the highest rates were the Southeast, South and Northeast for both sexes and specifically for women. The North region showed the greatest recent significant upward trend. Conclusions: During the last 38 years, Brazil has shown a significant increase in the trend of the mortality rate due to oral cavity/base of tongue and lip cancers in women. Preventive strategies with control of risk factors should be strongly emphasized in order to improve the survival rates of individuals with oral cavity/base of tongue and lip cancers. [ABSTRACT FROM AUTHOR]

Muscle strength measured by handgrip strength (HGS) was inversely and independently associated with high blood pressure (HBP). In addition, HGS has been used as a valuable indicator for monitoring pediatric health. This study aimed to investigate the association between HGS indexes and HBP, verify the discriminatory capacity of HGS to identify HBP in adolescents, and propose cut-points for HGS to be used in the early identification of HBP if good discriminatory power is identified between the variables. This was a cross-sectional study comprising 811 adolescents (male: 48.9%; age: 16.4 ± 1.3 years) from southern Brazil. Blood pressure was measured by the oscillometric method. Handgrip strength was assessed by a hand dynamometer and 3 different approaches were adopted: (a) HGS in kilogram-force, (b) normalized HGS (HGS/body mass), and (c) allometric HGS (HGS/body mass-0.67). Binary logistic regression was used to verify the association between HGS indexes and HBP, and the receiver operating characteristic (ROC) was used to determine the possible use of HGS as a diagnostic tool for HBP. Handgrip strength indexes were not associated with HBP (p > 0.05), and ROC analyses showed a nonsignificant discriminating accuracy for most of the HGS indexes analyzed (p > 0.05) in identifying HBP in boys and girls. The area under curve (AUC) values ranged from 0.499 (95% CI [0.403-0.596] for allometric HGS among overweight or obese boys) to 0.595 (95% CI [0.546-0.643] for HGS among boys). Handgrip strength was not associated with HBP, and its use in the screening of HBP in adolescents is not recommended. [ABSTRACT FROM AUTHOR]

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Objectives: This study aimed to investigate the influence of community water fluoridation on ethnic inequalities in untreated dental caries among children and adolescents in Brazil while taking the human development context into account. Methods: Data from a nationwide Brazilian epidemiological population oral health survey were used (SB Brazil 2010). Outcomes were caries prevalence measured by the proportion of individuals with one or more untreated decayed teeth and caries severity defined by the mean number of untreated decayed teeth (DT). Three different contexts were considered: 1—cities with no water fluoridation; 2—cities with water fluoridation and low Human Development Index (HDI); and 3—cities with water fluoridation and high HDI. The exposure was ethnic/racial group (White, Pardo, Black) and covariates were age, sex and household income. Multilevel logistic and negative binomial regressions were performed with 6696 children (aged 5 years) and 11 585 adolescents (aged 12 and 15‐19 years). Results: For both children and adolescents, ethnic differences in caries prevalence and mean DT were found in the nonfluoridated cities with low HDI and also in cities with high HDI, most of which were fluoridated. For example in nonfluoridated cities with low HDI, 5‐year‐old Pardo children were more likely to have untreated decay (OR = 1.22; 95% CI: 1.02, 1.46) and had more decayed teeth (RR = 1.18; 95% CI: 1.04, 1.34) than their White counterparts after adjusting for sex and household income. No statistically significant differences were observed in fluoridated cities with low HDI. Conclusion: Water fluoridation appears to be associated with reduced ethnic inequalities in dental caries prevalence and mean DT among children and adolescents in more disadvantaged settings. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Nursing & Health is the property of Journal of Nursing & Health (JONAH) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Cuidarte is the property of Universidad de Santander and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: Obesity is an important risk factor for chronic diseases and can also result in greater mortality. The aim of this longitudinal study was to investigate whether poor oral health acts as a risk factor for obesity as indicated by body mass index (BMI) and waist circumference (WC). Methods: We included in this analysis all participants who volunteered in a cohort study entitled 'Carlos Barbosa Cohort Study—CBCS' in the city of Carlos Barbosa, Southern Brazil. The interview questionnaire comprised socio‐demographic information, behavioural questions and medical history. Oral examinations and anthropometric assessments were carried out. The outcome was obesity measured by both BMI (≥30 kg/m2) and WC (>0.80 for women and >0.94 for men). Variables were collected longitudinally. Those associated with the outcome and epidemiologically relevant to the conceptual framework participated in the analysis and were adjusted for socio‐demographic, behavioural, general and oral health conditions. Results: Six hundred and thirty‐three independently living elders participated. The baseline mean age was 67.5 ± 6.1 years. Individuals who never visited a dentist (OR = 3.02, 95% CI: 1.25‐7.26) as well as participants who needed a dental prosthesis in the lower arch (OR = 4.38, 95% CI: 1.34‐14.32) were more likely to be obese, through BMI and WC measures, respectively. Edentulous participants with complete dentures in both arches (OR = 0.23, 95% CI: 0.06‐0.84) and those who perceived their oral health as unsatisfactory (OR = 0.41, 95% CI: 0.19‐0.88) had a lower likelihood of being obese, according to BMI and WC measures. Conclusions: Older persons with poor oral health may be at risk for general and central obesity, a relationship that may have important clinical implications. [ABSTRACT FROM AUTHOR]

Objectives: To investigate differences between Pardos (mixed) and Blacks with their White counterparts in the use of public dental service among a sample of Brazilian adults taking into consideration the role of individual and contextual characteristics. Methods: A total of 6196 adults aged 35‐44 years were sampled from the 2010 Brazilian National Oral Health Survey and nested in one of 27 Brazilian State Capitals. Binary multilevel logistic analyses were conducted. Use of public dental service in the last visit was the outcome, and self‐reported colour/race (Pardo, Black, White) was the explanatory variable. Individual covariates were sex, level of education, family income, self‐reported need for treatment, dental pain in the last 6 months, presence of decayed, filled and missing teeth. The State Capital covariates were proportion of Pardos/Blacks, Human Development Index, Gini coefficient, Integration of dental teams into Brazil Family Health Program and dentist per population rate. Results: Pardos and Blacks were 1.25 (95% CI 1.10‐1.42) and 1.73 (95% CI 1.41‐2.11) times, respectively, more likely to visit the public dental service than Whites. Adjustments for level of education and income were more relevant in affecting the estimates between groups than any other covariate, but differences persisted. Colour/race was independently associated with the type of service used in the last dental visit after fully adjusted for individual and State Capital characteristics. Conclusions: Racial differences in dental service utilization were evident for middle‐aged adults in Brazil. The results found highlight the importance of investments in public dental service as Pardos and Blacks relied more on this type of service than Whites. [ABSTRACT FROM AUTHOR]

Copyright of Jornal de Pediatria is the property of Sociedade Brasileira de Pediatria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: It is well known that oral health status is associated with oral health‐related quality of life (OHRQoL) in the general population. The aim of this study was to describe and analyse OHRQoL among older people in short‐term care and its associated factors. Materials and Methods: This cross‐sectional study included 391 older people in 36 short‐term care units. Data were collected via clinical oral assessments, questions about self‐perceived oral and general health, Katz Index of Activities of Daily Living (Katz‐ADL) and the Revised Oral Assessment Guide (ROAG). OHRQoL was measured using the Oral Health Impact Profile (OHIP‐14). Multivariate logistic regression models were applied in the analysis. Results: Poor OHRQoL was reported by 34% of the older people. Associated factors were swallowing problems according to ROAG; quite poor/poor self‐perceived physical, psychological and oral health; and being a woman. Conclusions: There is an association between OHRQoL and older people's self‐perceived health according to the OHIP‐14. This indicates the importance of early detection of oral health problems in frail older people and to assess both oral health and swallowing problems among older people in short‐term care. [ABSTRACT FROM AUTHOR]

Background: Tooth loss represents a known marker of health inequality. The association between tooth loss and unfavorable socioeconomic conditions is evident when analyzed at an individual level. However, the effects of contextual characteristics on tooth loss need to be better investigated and understood. The objective of this study was to analyze tooth loss among Brazilian adults (35–44 years of age), in accordance with individual and contextual social characteristics. Methods: This was a multilevel cross-sectional study with data from 9564 adult participants from the Brazilian Oral Health Survey - SBBrasil 2010. The dependent variable was the number of lost teeth and the independent variables were grouped into structural (socioeconomic & political context) and intermediary (socioeconomic position, behavioral & biological factors, and health services) determinants. Multilevel Hierarchical Negative Binomial Regression was conducted and the Mean Ratio (MR) was estimated. Results: Brazilian adults lost a mean of 7.57 (95% CI 7.1–8.1) teeth. Among the contextual variables, the number of teeth lost was higher among residents of municipalities with high and medium/low Municipal Human Development Index (MHDI) and in municipalities that did not have public water fluoridation. Among the individual variables, dental loss was higher among those who declared themselves yellow/black/brown/indigenous, were older, who had lower income, who had never visited a dentist, who had used dental services for more than a year and those whose most recent visit to the dentist was due to oral health problems. On the other hand, dental loss was lower among adults with higher education levels and males. Conclusions: The number of missing teeth was associated with unfavorable contextual and individual conditions, which reinforces the need to reduce social inequality and guarantee regular, lifetime access to dental services. [ABSTRACT FROM AUTHOR]

Objective: To analyse trends in dental pain prevalence among Brazilian adolescent students over 6 years, focusing on inequalities by maternal education. Methods: Data from the National Adolescent School‐Based Health Survey (PeNSE) carried out in 2009 (n = 45 239), 2012 (n = 46 482) and 2015 (n = 35 592) were analysed, including ninth grade students from the 27 state capitals in Brazil who were of ages 11‐17 years or older. Variables analysed were dental pain within the last 6 months (yes/no) and the following sociodemographic factors: age, sex, race, type of school and maternal schooling (years of study: ≤8; 9‐11; ≥12). The prevalence of dental pain in the 3 years was compared using the Rao‐Scott test. Relative and absolute measures of socioeconomic (maternal education) inequalities in dental pain were applied using the slope index of inequality (SII) and the relative concentration index (RCI). Results: The prevalence of dental pain increased from 17.5% (95% CI = 16.9‐18.2) in 2009 to 20.4% (95% CI = 19.7‐21.1) in 2012, then to 21.8% (95% CI = 21.1‐22.5) in 2015. All sociodemographic factors investigated were associated with dental pain in all survey years. There was an increasing proportion of the outcome in all categories of maternal education over the years studied. Absolute (SII) and relative (RCI) inequalities regarding of maternal education were found; these indicate higher levels of dental pain in the lower socioeconomic group in each study year. However, no significant changes in inequalities were found from 2009 to 2015. Conclusions: The prevalence of dental pain increased in the 2009‐2012 and 2012‐2015 periods, and social inequalities were found. Higher levels of dental pain persisted in the lower maternal education group. Inequalities remained stable over time. Broader actions to reduce the existing inequalities are needed and should be a priority for public policies. [ABSTRACT FROM AUTHOR]

Aims: To assess the presence of dental pain in child abuse victims and to compare the findings to children in the same age group with no history of abuse in a Southern Brazilian city. Methods: This cross-sectional comparative study was carried out in a convenience sample of 68 child abuse victims from a center for psychologic support and in a comparative group of 204 students from public and private schools, all aged between 8 and 12 years. Data for socioeconomic and demographic variables were collected, and information regarding dental pain in the last 6 months was obtained via interviews with the children. World Health Organization criteria were used to assess the presence of decayed, missing, or filled teeth in primary and permanent dentition. Dental trauma was measured using the O'Brien Index, and gingival bleeding was assessed. Crude and adjusted logistic regression analyses were performed to assess the association between dental pain and history of abuse. Results: Reporting of dental pain was higher among child abuse victims (54.41%) than in the comparative group (36.14%) (P < .01). After adjustment for clinical variables in the logistic regression analyses, the child abuse victims group had an odds ratio of 2.03 (95% confidence interval 1.13 to 3.64) for dental pain (P = .01). Conclusion: Child abuse victims presented a higher prevalence of dental pain than children with no history of maltreatment, regardless of oral health status. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to test associations between a municipal social development indicator and indicators of public dental services; examine differences in the achievement of public dental services goals between fluoridated and nonfluoridated municipalities; and, quantify contribution of a municipal social development indicator in estimated mean differences in the public dental services indicators between fluoridated and nonfluoridated municipalities. Methods: A secondary analysis of data from 293 municipal dental health services records from Southern Brazil between 2010 and 2015 was conducted. Multivariable log‐binomial regression models were fitted to test the associations between municipal Human Development Index (HDI) and multiple public dental services indicators (proportion of public dental health service coverage, the proportion of tooth extraction among all clinical procedures, and monthly participation in supervised tooth brushing). Cut‐off points for outcomes were based on state goals for public dental services. Blinder‐Oaxaca decomposition analyses were performed to quantify the relative contribution of HDI in the differences in outcomes according to the municipal water fluoridation status. Results: Municipalities within the lowest tertile of HDI had 66% lower prevalence of having insufficient public dental health service coverage (less than state goals)than those in the highest tertile of HDI (PR: 0.44; 95% CI: 0.24, 0.50). Municipalities with lowest HDI had nearly 30% higher prevalence of failing the state goals regarding the proportion of extraction and supervised tooth brushing (PR: 1.30; 95% CI: 1.20, 1.40 and PR: 1.34; 95% CI: 1.23, 1.45, respectively). Mean public dental health service coverage was higher in nonfluoridated municipalities than fluoridated municipalities, and municipal HDI explained 36% of the total estimated mean difference. Conclusions: This study found associations between municipal social development and public dental services indicators in Southern Brazil. However, higher HDI was associated with lower public dental health service coverage, lower proportion of extraction and higher coverage of supervised tooth brushing [Correction added on 2 April 2019, after first online publication: In the preceding sentence, the text "but with a higher proportion of extraction and supervised tooth brushing" was changed to "lower proportion of extraction and higher coverage of supervised tooth brushing"]. Municipal HDI contributed significantly towards the gap in public dental coverage between fluoridated and nonfluoridated municipalities, favoring nonfluoridated municipalities. These findings have important policy implications for reducing oral health inequalities as it highlights the interplay between key oral health policies and their distribution according to municipal social development. [ABSTRACT FROM AUTHOR]

Background: The pathway by which socioeconomic disadvantages are manifested in the occurrence of dental caries remains unclear. Aim: To explore how much the association between untreated dental caries and income inequalities is related to household food insecurity (HFI). Design: A population‐based study was conducted with a sample of 466 12‐year‐old students. Dental caries was evaluated by an examiner who had undergone calibration exercises. HFI was assessed using the Food Insecurity Scale validated for Brazilian Portuguese. Poisson regression models were created to determine associations between dental caries and both household income and HFI. The proportion of the income effect on dental caries explained by HFI was determined by the variation in percentages between the crude prevalence ratio (PRc) for dental caries and this measure adjusted by HFI (PRa). Results: The prevalence of dental caries was higher among children from families with a per capita household income lower than US$ 71 (PR: 1.69; 95%CI: 1.15‐2.49) or from US$ 71 to US$ 142 (PR: 1.50; 95%CI: 1.04‐2.17). Moreover, 14% of the association between a low income and dental caries was explained by HFI. Conclusions: Differences in the prevalence of dental caries in schoolchildren related to socioeconomic inequalities could partially be attributed to HFI in low‐income families. [ABSTRACT FROM AUTHOR]

Background The influence of life-course socioeconomic disadvantage on oral health at older ages is not well-established. We examined the influence of socioeconomic factors in childhood, middle-age and older age on oral health at older ages, and tested conceptual life-course models (sensitive period, accumulation of risk, social mobility) to determine which best described observed associations. Methods A representative cohort of British men aged 71–92 in 2010–12 included socioeconomic factors in childhood, middle-age and older age. Oral health assessment at 71–92 years (n = 1622) included tooth count, periodontal disease and self-rated oral health (excellent/good, fair/poor) (n = 2147). Life-course models (adjusted for age and town of residence) were compared with a saturated model using Likelihood-ratio tests. Results Socioeconomic disadvantage in childhood, middle-age and older age was associated with complete tooth loss at 71–92 years—age and town adjusted odds ratios (95% CI) were 1.39 (1.02–1.90), 2.26 (1.70–3.01), 1.83 (1.35–2.49), respectively. Socioeconomic disadvantage in childhood and middle-age was associated with poor self-rated oral health; adjusted odds ratios (95% CI) were 1.48 (1.19–1.85) and 1.45 (1.18–1.78), respectively. A sensitive period for socioeconomic disadvantage in middle-age provided the best model fit for tooth loss, while accumulation of risk model was the strongest for poor self-rated oral health. None of the life-course models were significant for periodontal disease measures. Conclusion Socioeconomic disadvantage in middle-age has a particularly strong influence on tooth loss in older age. Poor self-rated oral health in older age is influenced by socioeconomic disadvantage across the life-course. Addressing socioeconomic factors in middle and older ages are likely to be important for better oral health in later life. [ABSTRACT FROM AUTHOR]

Background To evaluate the association between sociodemographic conditions and the quality of life (QoL) in adults and investigate whether these inequalities are greater among individuals with long-lasting chronic health conditions. Methods Cross-sectional analysis of the second wave (2012) of the EpiFloripa Study, a population-based cohort of 1720 adults living in Southern Brazil. QoL domains (physical, psychological, social relationships and environmental) were evaluated using the WHOQoL-BREF. Unadjusted and adjusted means of QoL according to socioeconomic and demographic variables were estimated and stratified by the presence of long-lasting chronic conditions (heart disease, stroke, diabetes, hypertension, chronic kidney disease, cirrhosis, tendinitis, arthritis, rheumatism and/or fibromyalgia) were peformed in 2016. Results Among 1222 interviewed adults (56.6% females, mean age 41.7 ± 11.4 years; follow-up rate 71.1%), the prevalence of 1+ long-lasting chronic disease was 37.3% (95%CI: 34.4–40.3). Their effect on the QoL was four times higher on the physical component (−9.6; 95%CI −12.1; −7.1) than on the other domains. Adults aged 40+ years with black skin colour or lower educational level had a lower physical QoL score only when any chronic disease was present. Among those with some chronic illness, the psychological domain was also lower among those aged 40+ years and with a lower family income. No interaction between sociodemographic variables and chronic diseases was observed for the other QoL domains. Conclusions The occurrence of long-lasting chronic diseases is associated with inequalities in QoL (physical and psychological domains), with stronger adverse effects among older adults, blacks and individuals with lower income or educational levels. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To test whether maternal education has a direct effect on gingival bleeding in adolescents aged 12 and to assess whether oral health behaviours over time mediate that association. Methods: Two oral health studies nested in the 1993 Pelotas (Brazil) birth cohort study were carried out in participants aged 6 (n = 359) and 12 years (n = 339). The proportion of teeth with bleeding on probing (BOP) and the median number of teeth with gingivitis at age 12 were recorded. Maternal education at birth was the exposure. Toothbrushing frequency and dental visit at ages 6 and 12 years were investigated as mediators of the association between maternal education at birth and gingival bleeding. Time‐varying family income through childhood and adolescence was included as later confounder. Paternal education was taken as baseline confounder. The controlled direct effect (CDE) of maternal education at child's birth on gingival bleeding at age 12 was estimated using marginal structural models (MSM). Additionally, path analysis was employed to estimate standardized direct, indirect and total effects of maternal education at birth on gingival bleeding. Results: Adjusted analyses using MSM showed that adolescents whose mothers had <8 years of education had 3.82 higher risk of having teeth with gingival bleeding above the median (rate ratio RR 3.82; 95% CI: 1.68‐8.19). Low maternal education doubled the proportion of gingival bleeding at age 12 not mediated by dental visit and toothbrushing frequency (RR 1.99; 95% CI: 1.52‐2.60). Path analysis revealed that maternal education had a direct effect on gingival bleeding independently of the mediators. Conclusions: The pattern of oral health behaviours does not explain the association between mother's education and adolescent's gingival bleeding. Individual‐based approaches focused on oral health‐related behaviours tend to fail to prevent gingival bleeding. [ABSTRACT FROM AUTHOR]

Background: Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen’s behavioural model. Methods: Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes. Results: Predisposing (OR = 0.89; 95% CI 0.81–0.97) and enabling (OR = 0.90; 95% CI 0.85–0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics. Conclusions: Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services. [ABSTRACT FROM AUTHOR]

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Aims and objectives To present a systematic review of papers published on the relationship between violence against women and cervical cancer screening. Background Violence against women is a serious public health problem. This phenomenon can have negative effects on victims' health and affect the frequency at which they receive cervical cancer screening. Design A systematic literature review. Methods This study was carried out in October 2015 with searches of the Lilacs, PubMed and Web of Science databases using the following keywords: violence, domestic violence, battered women, spouse abuse, Papanicolaou test, vaginal smears, early detection of cancer and cervix uteri. Results Eight papers published between 2002-2013 were included in this review, most of which were cross-sectional studies. Three studies found no association between victimisation and receiving Pap testing, and five studies reported an association. These contradictory results were due to higher or lower examination frequencies among the women who had experienced violence. Conclusion The results of this study indicate that the association between violence against women and cervical cancer screening remains inconclusive, and they demonstrate the need for more detailed studies to help clarify this relationship. Relevance to clinical practice Professionals who aid women should be knowledgeable regarding the perception and detection of violence so that they can interrupt the cycle of aggression, which has harmful impacts on victims' health. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to investigate the associated factors of changes in symptoms of xerostomia (SOX) in adults aged 20-59. Methods A prospective population-based study was conducted in 2009 ( n = 1720) and 2012 ( n = 1222) in the urban area of Florianópolis, SC, Brazil. Information on SOX was collected in both years together with age, family income, years of schooling, smoking habit, alcohol consumption, changes in the body mass index ( BMI; kg/m²), medicine use, self-reported diagnosis of chronic diseases, change in hypertension status and in the use and need for dentures, and number of remaining teeth. Associated factors with changes in SOX were investigated using multinomial logistic regression, considering those who had never reported this symptom as the reference. Results Prevalence of regular SOX was equal to 3.8% (95% CI: 2.9-5.1) and irregular (one period only) equal to 12.2% (95% CI: 10.2-14.5). Age, smoking habit, medicine use, self-reported diagnosis of depression, and weight gain increased the probability of regular SOX, whereas highest schooling level was associated with lower probability of this symptom. Conclusions General and psychosocial health influenced the number of episodes of xerostomia symptoms, calling for multidisciplinary actions to prevent common risk behaviors for oral and general diseases. [ABSTRACT FROM AUTHOR]

We aimed to estimate hypothetical effects of habits (smoking, alcohol consumption, and fat and carbohydrates consumption) combined with diet-induced overweight/obesity on the risk of periodontitis. The risk of any periodontitis, moderate/severe periodontitis, and the combination of bleeding on probing (BOP) and clinical attachment loss (CAL) was estimated using the parametric g-formula in adults aged 31 years from the 1982 Pelotas Birth Cohort in Brazil. Individuals in this cohort have been followed since birth. Hypothetical conditions were set independently for each risk factor and in combination for the entire population. A total of 539 participants had oral examinations in 2013. The cumulative 31-year risk under no intervention was 33.3% for any periodontitis, 14.3%, for moderate/severe periodontitis, and 14.7%, for BOP and CAL. According to our statistical approach, diet-induced overweight/obesity increased the risk of all outcomes: 11% (overweight) and 22% (obesity) higher risk of periodontitis; 12% (overweight) and 27% (obesity) higher risk of moderate/severe periodontitis; 21% (overweight) and 57% (obesity) higher risk of CAL and BOP. When overweight/obesity was combined with other unhealthy habits, the risk was even greater. Our findings suggest that the combination of diet-induced obesity with other risk factors may increase the risk of periodontitis. Further research in the field is required to corroborate our study. [ABSTRACT FROM AUTHOR]

Background: In recent decades middle-income countries have experienced a rapid increase in the number of cars and motorcycles. Increased deaths and hospitalizations due to road traffic injuries (RTI) has been observed in several countries as a result. In this study we assessed the determinants of RTIs in Brazil by mode of transportation and compared differences in RTI rates among macro-regions. Methods: We used data from the National Health Survey (NHS) conducted in 2013 by the Brazilian Institute of Geography and Statistics and the Ministry of Health. NHS is a comprehensive household survey which includes a representative sample (N = 60,198) of individuals aged 18 years or older. The prevalence and determinants of RTI were estimated according to different modes of transport (car/van, motorcycle, and other) and regions of the country. Bivariate and multivariable logistic regression models were applied to assess crude and adjusted odds ratios, respectively, and their 95 % CI for RTI determinants. Results: The prevalence of RTI for the Southeast, South, Central-West, Northeast and North regions of Brazil was 2.4 %, 2.9 %, 4.4 %, 3.4 % and 4.8 %, respectively, pointing to important differences among regions. High percentages of motorcyclists were observed in the Northeast and North regions. For motorcyclists, factors associated with RTIs were being male (OR = 2.6;95 % CI:2.3;3.0), aged 18-29 (OR = 3.2; 95 % CI:2.7;3.8) and 30-39 years (OR = 2.0;95 % CI:1.7;2.5), black (OR = 1.4;95 % CI:1.1;1.7), having elementary educational (OR = 1.5;95 % CI:1.1;1.9), reporting binge drinking behavior (OR = 1.3;95 % CI:1.1;1.5), and living in the Central-West (OR = 2.0;95 % CI:1.6;2.5), Northeast (OR = 1.8;95 % CI: 1.5;2.1) and North (OR = 2.0;95 % CI:1.6; 2.5) regions of the country. The independent variables associated with RTI for car/van occupants were being male (OR = 1.7;95 % CI:1.4;2.1), aged 18-29 (OR = 1.5;95 % CI:1.1;2.0) and 30-39 years (OR = 2.5;95 % CI:1.9;3.2), reporting binge drinking behavior (OR = 2.0;95 % CI:1.6;2.5) and living in the South region (OR = 1.6;95 % CI:1.3;2.1). Conclusions: There were considerable regional disparities in RTI rates across Brazil's regions. Motorcyclists contributed to the high RTI rates in these regions as did demographic factors and behaviors such as alcohol use. These findings can help guide interventions to reduce the burden of RTIs in Brazil. [ABSTRACT FROM AUTHOR]

Conclusions:Passive smoking and COF exposure are independent risk factors for oral cancer in Chinese women, with the multiplicative interactions from combined exposures. Avoiding exposure to environmental tobacco smoke and COF may contribute to the prevention of oral cancer in Chinese women. Objective:To evaluate the independent and joint effects of passive smoking and cooking oil fumes (COF) on oral cancer in Chinese women. Methods:A case-control study was performed including 238 female patients with pathologically confirmed oral cancer and 470 controls as age-matched controls. Face-to-face interviews were conducted based on a structured questionnaire. The effects of passive smoking and COF exposure were analyzed using non-conditional logistic regression models. Results:Passive smoking significantly increased the risk of oral cancer in Chinese women: adjusted ORs were 2.12 (95% CI = 1.11–4.07) for those only exposed before age 18, 1.52 (95% CI = 1.01–2.31) for those only exposed after age 18, and 2.38 (95% CI = 1.47–3.85) for those both exposed before and after age 18. In addition, COF exposure was significantly associated with a risk of oral cancer (adjusted ORs were 1.69 (95% CI = 1.03–2.78) for light exposure and 2.06 (95% CI = 1.21–3.50) for heavy exposure). Furthermore, there was a significantly multiplicative interaction between passive smoking and COF for oral cancer. [ABSTRACT FROM PUBLISHER]

Objective To assess whether short-term changes in income (IC) in adulthood were associated with self-rated oral health (SROH) and chewing difficulties (CD). Methods Secondary analysis of a longitudinal study in Florianópolis, Southern Brazil ( EpiFloripa); a total of 1720 adults participated in 2009 and 1223 in 2012. Logistic regression analysed the variation of SROH and CD according to short-term changes in income (IC) groups ('high income-stable', 'increased income', 'decreased income' and 'low income-stable') and adjusted for covariates (age, sex, marital status, skin colour, self-reported number of teeth and education). Results After adjusting for covariates, participants in the 'decreased income' were more likely to have poor SROH and CD than those at the 'high income-stable' group (OR: 1.78, 95% CI: 1.23, 2.58; OR: 2.76, 95% CI: 1.61, 4.74, respectively). Significant differences were also found between the 'low income-stable' and 'high income-stable' groups, but these differences were explained when adjusted for potential confounders. There were no significant differences in SROH and CD between the 'increased income' and the 'high income-stable' groups. Conclusions Overall, SROH and CD were adversely influenced by negative changes in income during adulthood in a short period of 3 years. [ABSTRACT FROM AUTHOR]

Background We examined the relation of tobacco and alcohol consumption after total laryngectomy with overall survival (OS). Methods Tobacco and alcohol consumption was assessed at 5 time points after total laryngectomy. Patients were followed up for survival until December 31, 2014. A multivariate Cox regression was fitted to test for differences in OS. Results Three hundred fifty-nine patients were included in this study. Compared to former smokers, never smokers had hazard ratios (HRs) of 0.88 (95% confidence intervals [CIs] = 0.50-1.59), and continuous smokers 1.31 (95% CI = 0.87-1.96). Constantly high alcohol consumption after total laryngectomy had an HR of 2.19 (95% CI = 1.30-3.67). Duration of smoking (HR = 1.00; 95% CI = 0.99-1.01) and last known status of alcohol consumption (HR = 1.00; 95% CI = 0.76-1.33) was not related to OS. Conclusion Patients who smoke after total laryngectomy have a 30% higher risk of dying than people who gave up smoking, and constant high alcohol consumption is also a strong risk factor for dying. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1324-1329, 2016 [ABSTRACT FROM AUTHOR]

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This study tested whether the pattern of dental services utilization and the reason for the last dental visit mediate the association between educational attainment and dental pain. This is a cross-sectional analysis ( n = 1099) based on data from a prospective cohort study in adults, southern Brazil. The mediating effects were assessed by including interaction terms in logistic regression models and by the KHB method, which estimated the direct, mediated, and total effects of education on dental pain. The prevalence of dental pain was 17.5%. Individuals with less than 12 yr of study who visited the dentist to solve dental problems had a 20% higher odds of reporting dental pain than those with 12 or more years of study, who sought the dentist for preventive reasons. Dental services should also focus on preventive measures, especially if less-educated individuals visit the dentist only to treat problems; this may help reduce the frequency of negative oral health outcomes, including dental pain. [ABSTRACT FROM AUTHOR]

Oral health inequalities are the measures by which equity in oral health is tracked. Despite widespread improvement in children's dental health globally, substantial socio-economic disparities persist and may be worsening. Objectives Quantify 10-year changes in child caries occurrence by socio-economic position in a Southern Brazilian city and compare oral health inequalities over time. Methods Representative surveys of dental caries in children (age <6 years) in Canoas, Brazil, were conducted in 2000 and 2010 following standardized methods. For each survey year, we calculated disparities by socio-economic position (maternal education and family income) in age- and sex-standardized caries occurrence (prevalence: dmft > 0; severity: mean dmft) using absolute measures (difference and Slope Index of Inequality) and relative measures (ratio and Relative Index of Inequality). Results Comparing 2010 to 2000, caries occurrence was lower in all socio-economic strata. However, reductions were more pronounced among socio-economically advantaged groups, yielding no improvement in children's oral health disparities. Some disparity indicators were consistent with increasing inequality. Conclusions Overall, dental caries levels among children in Canoas improved, but inequalities in disease distribution endured. Concerted public health efforts targeting socio-economically disadvantaged groups are needed to achieve greater equity in children's oral health. [ABSTRACT FROM AUTHOR]

Background: Access to medicines is one of the major challenges in health policy. The high out-of-pocket expenditures on medicines in the Latin American and Caribbean (LAC) region represents important barrier to affordable access to care for NCDs. This paper aim to identify key barriers in access to medicines for household members with a diagnosed chronic condition in three Central America countries. Methods: This was a cross-sectional analytic study, based on data from three household surveys using a common methodology. We examined associated factors to: (1) seeking care for chronic illness from a trained clinician in the formal health system, and (2) obtaining all medicines sought for the chronic conditions reported. Results: A chronic condition was reported in 29.8 % (827) of 2761 households - 47.0, 30.7 and 11.8 % in Nicaragua, Honduras and Guatemala, respectively. The three main chronic conditions reported were hypertension, arthritis, and diabetes. Seeking care in the formal health system ranged from 73.4 % in Nicaragua to 83.1 % in Honduras, while full access to medicines varied from 71.6 % in Guatemala to 88.0 % in Honduras. The main associated factors of seeking care in the formal health system were geographic location, household head gender, Spanish literacy, patient age, perceived health status, perceived quality of public sector care, household economic level, and having health insurance. Seeking care in the formal health system was the main bivariate associated factor of obtaining full access to medicines (OR: 4.3 95 % CI 2.6 - 7.0). The odds of full access to medicines were significantly higher when the household head was older than 65 years, medicines were obtained for free, households had higher socioeconomic status, and health care was sought in the private sector. Conclusions: The nature of the health system plays an important role in access to medicines. Access is better when public facilities are available and function effectively, or when private sector care is affordable. Thus, understanding how people seek care in a given setting and strengthening key health system components will be important strategies to improve access to medicines, especially for populations at high risk of poor access. [ABSTRACT FROM AUTHOR]

Objectives To determine the incidence and predictors of coronal caries among community-dwelling elderly in a southern Brazilian city. Methods A cohort study was conducted using a simple random sample of persons aged 60 years or older in Carlos Barbosa city, southern Brazil. Interviews and oral examinations were conducted among 388 dentate individuals at baseline and among 273 at 4-year follow-up. The incidence of coronal caries was modeled by means of negative binomial regression. Results Some 184 (76.7%) participants presented with new coronal caries lesions or restorations, whose mean number was 2.2 ± 2.1, whereas the 4-year mean coronal caries incidence rate was 0.28 ± 0.29. In the multivariate model that controlled for baseline predictors, older age, male gender, living in a rural area, current smoking, and negative self-perception of oral health were associated with coronal caries incidence. Among clinical variables, the use of partial dentures was a predictor, whereas higher saliva flow rate was a protective factor for the outcome. Conclusions Demographic factors, primary determinants of health, behavioral, and clinical variables were predictors of the incidence of coronal caries. As people enter old age, even stronger emphasis should be put on preventive strategies. [ABSTRACT FROM AUTHOR]

Objectives A cross-sectional study was carried out to investigate the determinants of self-rated oral health among community-dwelling older people in Japan. Methods The participants were 897 (357 men and 540 women) aged 65 years and over who participated in a comprehensive geriatric health examination, which included an oral examination, a face-to-face interview assessing cognitive function, questionnaires regarding depressive symptoms and functional capacity, and a medical examination. The oral examination measured indices of oral health status: number of present teeth, number of functional teeth, occlusal force and amount of resting saliva. Multiple logistic regression analyses were carried out to determine the factors associated with poor self-rated oral health. Results The mean age of the participants was 73.5 ± 5.0 years. The prevalence of poor and rather poor self-rated oral health was 11.5% and 29.5%, respectively. Multiple logistic regression analyses showed that the number of present teeth (odds ratio [ OR] 0.97, 95% confidence intervals [ CI] 0.95-0.99), difficulty in mastication ( OR 3.20, CI 2.18-4.70), presence of xerostomia ( OR 1.43, CI 1.02-2.01), total score on the MoCA-J ( OR 1.06, CI 1.01-1.11), and reduction in frequency of leaving the house ( OR 1.64, CI 1.12-2.41) were significantly associated with poor self-rated oral health. Conclusions The present results suggested that self-rated oral health was a significant factor in oral health status as well as overall well-being among community-dwelling older Japanese people. Geriatr Gerontol Int 2015; 15: 755-761. [ABSTRACT FROM AUTHOR]

Objective To assess changes over time of the absolute and relative household income-related inequalities in inadequate dentition (ID) among Australians, Brazilians and USA adults. Methods This study used nationwide oral health survey data from Australia ( n = 1200 in 1999; n = 2729 in 2005), Brazil ( n = 13 431 in 2003; n = 9779 in 2010) and USA ( n = 2542 in 1999; n = 1596 in 2005). Absolute income inequalities were calculated using Absolute Concentration Index (ACI) and Slope Index of Inequality (SII), while relative inequalities were calculated using Relative Concentration Index (RCI) and Relative Index of Inequality (RII). Results Prevalence of ID in the studied period dropped from 8.7% to 3.1% in Australia; from 42.1% to 22.4% in Brazil; and remained stable in USA, nearly 8.0%. Absolute income inequalities were highest in Brazil, followed by the USA and Australia; relative inequalities were lower in Brazil than in Australia and the USA. ID was higher among Brazilian females (2010) and for the poorest group in all countries and periods. A remarkable reduction in absolute inequalities were found in Australia [Slope Index of Inequality (SII) and AIC 60%] and in Brazil (SII 25%; ACI 33%) while relative inequalities increased both in Australia (RCI and RII 40%) and in Brazil (RCI 24%; RII 38%). No changes in absolute and relative income inequalities were found in the USA. Conclusion There were still persistent absolute and relative income inequalities in ID in all examined countries. There has been a reduction in absolute income inequalities in ID but an increase in relative income inequalities. [ABSTRACT FROM AUTHOR]